Contact ulcers and granulomas of the larynx: new insights into their etiology as a basis for more rational treatment.

Repeated analysis of cinephotographic and cinefluorographic studies, correlated with clinical observations, has helped elucidate the causes of contact ulcers. Habitual throat clearing, excessive glottic attack in initiation of speech, and, most important, acid regurgitation secondary to hiatal hernia are the causal factors of contact ulcers. Contact granulomas produced by intubation trauma and other granulomas are compared and discussed. The successful treatment of contact ulcers and granulomas is dependent on elimination of vocal abuse, cessation of throat clearing, and control of the factors that cause the irritation and throat clearing.